Surgical management of multiple cavernous venous malformations in the orbit
Author: Stéphanie Goes
Base Hospital / Institution: The Eye Hospital Rotterdam
Video presentation
Abstract ID: 25-566
Purpose
To report a case of necrobiotic xanthogranuloma (NXG) manifesting in the lacrimal sac, a site not previously described in literature.
Methods
An 88-year-old male patient presented with a painless, firm and red swelling of the left medial canthal region since six months. Initial antibiotic therapy led to partial resolution. MRI showed a poorly defined lesion centered in the lacrimal sac with posterior extension, suspicious for malignancy. No signs of acute infection or systemic symptoms were noted. An incisional biopsy was performed under local anaesthesia.
Results
Histopathology revealed a dense infiltrate of foamy histiocytes, lymphocytes, and plasma cells with focal necrobiotic collagen. Immunohistochemistry was positive for CD163, CD68, CD14, CD4; negative for S100, CD1a, and BRAF. IgG4/IgG ratio <40%. Molecular analysis found no relevant mutations. Diagnosis: necrobiotic xanthogranuloma.
Conclusion
To our knowledge, this is the first reported case of NXG involving the lacrimal sac. The lesion’s clinical and radiological features closely mimicked malignancy. Histological confirmation was key. Given the patient’s age, absence of systemic involvement, and stable symptoms, a conservative, multidisciplinary approach was chosen. The patient was referred to immunology to evaluate for associated systemic lesions, and to assess the indication for systemic treatment. This case underscores the importance of including NXG in the differential diagnosis of lacrimal sac masses.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Dion | Paridaens | The Eye Hospital Rotterdam |
| S. | Khatab | The Eye Hospital Rotterdam |
